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15.03.2016 | How I Do it - Spine | Ausgabe 5/2016

Acta Neurochirurgica 5/2016

Percutaneous radiofrequency thermocoagulation of dorsal ramus branches as a treatment of “lumbar facet syndrome” - How I do it

Zeitschrift:
Acta Neurochirurgica > Ausgabe 5/2016
Autoren:
Mattia Pacetti, Pietro Fiaschi, Sergio Gennaro
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00701-016-2759-7) contains supplementary material, which is available to authorized users.

Key Points

1. Chronic lumbar pain is a common condition, sometimes due to an irritative arthropathy of zygapophyseal joint involving dorsal primary ramus of the spinal nerve.
2. Fluoroscopic-guided percutaneous radiofrequency thermocoagulation of posterior ramus nerve branches is a safe and reliable technique for the treatment of lumbar facet syndrome.
3. The procedure is simple, quick, and can be done as an outpatient.
4. The procedure does not alter the anatomical integrity of the spinal nerve.
5. Careful selection on clinical basis (localization of pain, absence of neurological deficit, positive anesthetic block test).
6. Careful selection on radiological basis (no signs of radiological instability).
7. Reduction of pain after anesthetic block test is the strongest predictor of good outcome after RF denervation.
8. The procedure is safe and repeatable.
9. Transitory dermographism phenomenon could be related to a satisfactory outcome.
10. Optimum outcome is absence of low back pain for 6 months to 1 year; in most of our cases longer.

Abstract

Background

Low back pain is an extremely common and often chronic condition. In some cases, this is due to an irritative arthropathy of zygapophyseal joint involving the medial branch of the dorsal ramus of the spinal nerve. Percutaneous radiofrequency thermocoagulation appears to be the most effective treatment to date, among a range of different treatments. In this paper, the technique is described as performed at out institution.

Methods

In supine position and under fluoroscopic control, a radiofrequency electrode is inserted into different articular zygapophyseal complexes to thermocoagulate ramifications of the medial branch of the dorsal primary ramus of the spinal nerve.

Conclusions

Fluoroscopic-guided percutaneous radiofrequency thermocoagulation of dorsal rami branches is a safe and reliable technique for the treatment of lumbar facet syndrome. Careful selection of patients based on clinical presentation and positive anesthetic block test are key points for an optimum outcome.

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Zusatzmaterial
ESM 1
The attached video shows one step of the procedure. The cannula is positioned as described in the text, local anesthesia is injected, the probe is inserted, and the position is corrected under fluoroscopic control. Then thermocoagulation is performed. The probe is moved as described in the text and thermocoagulation is repeated. (MP4 167455 kb)
Literatur
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